Guzik Przemysław, Rogacka Dorota, Trachalski Janusz, Minczykowski Andrzej, Baliński Marek, Wykretowicz Andrzej, Wysocki Henryk
Department of Cardiology, Intensive Therapy and Internal Diseases, Poznan University of Medical Sciences, Poland.
Kardiol Pol. 2007 Mar;65(3):262-9; discussion 270-1.
Typical chest pain and ECG changes suggest the presence of myocardial ischaemia in cardiac syndrome X (SX) patients and resemble the symptoms observed in subjects with atherosclerotic coronary artery disease (CAD).
To compare the results of exercise treadmill tests (ETT), 24-hour ECG recordings and echocardiography in SX and CAD patients without previous myocardial infarction with the presence of significant lumen stenosis in one (CA1), two (CA2) or three (CA3) coronary arteries.
Two hundred six patients were included in the study: 43 SX (28 female), 49 CA1 (11 female), 51 CA2 (7 female) and 63 CA3 patients (8 female) all of whom underwent ETT according to the Bruce protocol, 24-hour ECG recordings and echocardiography.
SX patients had median ST-segment depression during ETT comparable to that in CA1 and CA2 patients but significantly less than the CA3 subjects (p=0.024). Median time to ST depression of at least 1 mm, as well as median time of exercise, was significantly longer in SX individuals than in all CAD patients. The post-exercise recovery time of ST-segment changes was significantly longer in SX patients than in the CA1 group (p=0.006), comparable to that in CA2 subjects and shorter than that in CA3 individuals (p=0.003). Both the maximal ST-segment depression and the duration of significant ST-segment depression in Holter ECG recordings were significantly higher in SX patients than in CA1 subjects, were comparable to the values observed in the CA2 group and significantly lower than in CA3 individuals. The heart rate variability parameters (SDNN and pNN50) were significantly higher in SX patients than in CAD subjects. Patients with SX had a significantly thinner interventricular septum and smaller left ventricular end-diastolic cavity dimension than individuals from the CA1, CA2 and CA3 groups. There were no significant differences in the left ventricular ejection fraction or the thickness of the left ventricular posterior wall between SX patients and CAD patients.
Analysis of the ST segment in SX patients suggests the presence of advanced CAD. However, SX patients have better heart rate variability and exercise performance than patients with CAD.
典型胸痛和心电图改变提示心脏综合征X（SX）患者存在心肌缺血，且与动脉粥样硬化性冠状动脉疾病（CAD）患者的症状相似。
比较SX患者与无既往心肌梗死且单支（CA1）、双支（CA2）或三支（CA3）冠状动脉存在明显管腔狭窄的CAD患者的运动平板试验（ETT）、24小时心电图记录及超声心动图结果。
206例患者纳入本研究：43例SX患者（28例女性）、49例CA1患者（11例女性）、51例CA2患者（7例女性）和63例CA3患者（8例女性），所有患者均按照Bruce方案进行ETT、24小时心电图记录及超声心动图检查。
SX患者ETT期间ST段压低中位数与CA1和CA2患者相当，但显著低于CA3患者（p = 0.024）。SX患者至少压低1 mm的ST段压低时间中位数以及运动时间中位数显著长于所有CAD患者。SX患者运动后ST段改变的恢复时间显著长于CA1组（p = 0.006），与CA2患者相当且短于CA3患者（p = 0.003）。动态心电图记录中，SX患者的最大ST段压低及显著ST段压低持续时间均显著高于CA1患者，与CA2组观察值相当且显著低于CA3患者。SX患者的心率变异性参数（SDNN和pNN50）显著高于CAD患者。与CA1、CA2和CA3组患者相比，SX患者的室间隔显著更薄，左心室舒张末期内径更小。SX患者与CAD患者的左心室射血分数或左心室后壁厚度无显著差异。
对SX患者ST段的分析提示存在重度CAD。然而，SX患者的心率变异性和运动表现优于CAD患者。
